25.8. NCCN Clinical Practice Guidelines In Oncology (NCCN Guidelines®) for Multiple Myeloma V.2.2019

Chapter 25
Section Contents

These guidelines developed by the National Comprehensive Cancer Network® (NCCN®) address diagnosis, treatment, follow-up and response assessment for patients with MM [1213]. The most recent version of the NCCN Guidelines® for Multiple Myeloma (V.2.2019) is available at [592]. These guidelines include the following uses of sFLC measurements:

Initial diagnostic workup

sFLC analysis is recommended in the initial diagnostic work-up of all patients with suspected MM and related plasma cell disorders. Use of the sFLC assays, along with SPE and sIFE, yields high diagnostic sensitivity when screening for MM and related plasma cell disorders. These guidelines also note the prognostic value of sFLC assays in plasma cell disorders including MGUS, SMM, AL amyloidosis and solitary plasmacytoma.

Diagnostic categories

The NCCN Guidelines include the IMWG updated diagnostic criteria for SMM and MM (Section 25.2.1). These criteria include an involved/uninvolved sFLC ratio ≥100 as a myeloma defining event.

Surveillance/follow-up tests

The NCCN Guidelines recommend sFLC analysis for monitoring cases of active MM following primary and additional treatments, as clinically indicated. sFLC analysis is also recommended for monitoring solitary plasmacytoma after primary treatment, and for monitoring SMM as clinically indicated.

Response criteria

The NCCN Guidelines recommend use of the IMWG uniform response criteria in future clinical trials. These response criteria include sFLC analysis, and are described in Section 25.3.5.